Citation Nr: 0101541
Decision Date: 01/19/01 Archive Date: 01/24/01
DOCKET NO. 93-14 780 ) DATE
)
)
Received from the
Department of Veterans Affairs (VA) Regional Office in New
York, New York
THE ISSUE
Entitlement to service connection for a psychiatric disorder.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of
the United States
ATTORNEY FOR THE BOARD
Suzie S. Gaston, Counsel
INTRODUCTION
The veteran had active military service from December 1982 to
December 1987.
Service connection for a psychiatric disorder was denied by
the Board of Veterans' Appeals (hereinafter Board) in
September 1991.
This current matter came before the Board on appeal from a
rating action of September 1992, by the San Juan Regional
Office (RO), which denied the veteran's attempt to reopen his
claim of entitlement to service connection for a psychiatric
disorder. The notice of disagreement with that determination
was received in January 1993. The statement of the case was
issued in February 1993. The substantive appeal was received
in March 1993. The appeal was received at the Board in July
1993.
In a May 1995 decision, the Board reopened the veteran's
claim of service connection for a psychiatric disorder, based
upon a finding that new and material evidence had been
submitted in support of the claim; the claim was remanded to
the RO for additional development of the evidence and a de
novo review of the entire claims folder. Medical records
were later received from the Social Security Administration
(SSA) in January 1996. Additional medical records were
received in January 1997, April 1997, and March 1998. A
supplemental statement of the case (SSOC) was issued in
November 1998. A Department of Veterans Affairs (VA)
compensation examination was conducted in July 1999, and a
subsequent addendum was received in March 2000. Another SSOC
was issued in May 2000.
The veteran has been represented since October 1998 by the
Veterans of Foreign Wars of the United States. When the
appeal was returned to the Board in August 2000, it was
referred to the service organization, which submitted written
argument to the Board in August 2000.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran's appeal has been obtained by the
RO.
2. The veteran's psychiatric disorder, currently diagnosed
as bipolar disorder, clearly and unmistakably preexisted his
military service.
3. The veteran's preexisting psychiatric disorder did not
permanently increase in severity beyond normal progression
during service.
CONCLUSIONS OF LAW
1. The veteran's psychiatric disorder, irrespective of its
diagnostic classification, clearly and unmistakably existed
prior to service, and the presumption of soundness at entry
is rebutted. 38 U.S.C.A. §§ 1131, 1137, 5107(b) (West 1991);
38 C.F.R. §§ 3.304, 3.306 (2000); Pub. L. No. 106-475, § 4,
114 Stat. 2096, ____ (2000) (to be codified as amended at
38 U.S.C.A. § 5107(b)).
2. The veteran's preexisting psychiatric disorder was not
aggravated during service. 38 U.S.C.A. §§ 1131, 1137, 1153,
5107(b) (West 1991); 38 C.F.R. §§ 3.304, 3.306, 4.9, 4.27
(2000); Pub. L. No. 106-475, § 4, 114 Stat. 2096, ____ (2000)
(to be codified as amended at 38 U.S.C.A. § 5107(b)).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Factual background
The record reflects that the veteran entered active duty in
December 1982; an enlistment examination, conducted in
October 1982, was negative for any complaints or clinical
findings of a psychiatric disorder. The service medical
records reflect that the veteran was referred to a
psychiatric technician in May 1983, because of depression and
an inability to cope with Navy life; at that time, the
veteran requested a discharge from service. However, on
examination psychiatric findings were normal.
In October 1986, the veteran was discharged from service for
the purpose of immediate reenlistment. When he underwent a
reenlistment examination, he once again complained of
depression and excessive worry; however, psychiatric findings
were reported as normal upon clinical evaluation.
The veteran also complained of depression and frustration in
August 1987. At this time, the assessment was immature
personality disorder with low stress tolerance and depressed
mood; and "rule out" alcohol abuse. He sought treatment at
the mental health clinic from August through December 1987.
In August 1987, he was diagnosed with mixed substance abuse,
"rule out" dependence; personality disorder, antisocial and
dependent. In September 1987, he reported episodic alcohol
binges and stated that he could drink up to one pint per
night. He also complained of recurrent suicidal thoughts for
the past 10 years, with one suicidal gesture in 1984. The
veteran gave a history of multiple behavioral problems in
school since grade six, and of legal problems. He said he
had dropped out of school in the 10th grade. Pertinent
diagnosis included personality disorder, antisocial,
dependent, and decompensation.
The service medical records also reflect that the veteran was
hospitalized from late November to early December 1987 for
evaluation of poor impulse control; at that time, he gave a
history of alcohol abuse since age 13, without prior
treatment, and of heavy polysubstance abuse prior to service.
Although he reported alcohol use during service, he denied
any drug use during service. He had been advised to attend
Alcoholics Anonymous several months before admission, but had
been noncompliant. Clinical data reported evidence of
sociopathic behavior before service, including involvement as
a member of a street gang, and four arrests prior to service,
for larceny, burglary, assault, and vandalism. His family
history was remarkable for "nervous breakdowns" with
hospitalization of his mother and brother, and alcoholism in
his brother. The veteran further reported a history of heavy
polysubstance abuse (THC, cocaine, LSD, and amphetamines)
prior to service.
At the conclusion of the hospital course, the veteran's
treating physician diagnosed alcohol abuse; psychoactive
substance abuse; and mixed personality disorder, manifested
by immature and antisocial traits with numerous arrests,
frequent lying, polysubstance abuse, vandalism, stealing,
fighting, poor impulse control and failure to maintain a
monogamous relationship. It was further reported that the
veteran was not considered to be mentally ill, but that he
manifested a longstanding disorder of character and behavior
of such severity as to render him incapable of serving
adequately on active duty.
At his service discharge examination in December 1987, the
veteran complained of depression. However, the psychiatric
examination was normal. The record of his final discharge
from service, on DD Form 214, indicates that the reason for
separation was "personality disorders."
Received in July 1988 was an undated private report of
treatment from Carlos T. Vargas, M.D. who noted that the
veteran presented with symptoms of a chronic depressive
disorder, which, according to his history, had developed
during service. Dr. Vargas diagnosed dysthymia, primary
type, early onset, and recommended that the veteran continue
with psychiatric treatment.
The veteran also sought VA treatment for his condition from
February to May 1988. His complaints included depression,
boredom, insomnia, anger, irritability, social withdrawal,
and apathy. He was diagnosed as having a borderline
personality disorder and alcohol abuse. The veteran was
hospitalized from April to May 1988 due to a suicide attempt.
At this time, the examiner diagnosed an adjustment disorder
and depressed mood.
Received in November 1988 were various letters dated in July
1983, July 1984, August 1984, and June 1988 from the
Assistant Secretary of the Navy to the veteran's mother, in
response to her requests for information. These letters
contained statements to the effect that the veteran had
experienced some problems with adjustment to military life
and, although he performed satisfactorily, he was eventually
discharged from military service due to a personality
disorder. Additional copies of those letters were
subsequently received in August and October 1989.
Received in April 1989 were VA outpatient treatment reports
dated from April 1988 to January 1989, which show that the
veteran received clinical attention and treatment for several
disabilities, including a psychiatric disorder. The records
note the episode when the veteran was admitted to a VA
hospital in April 1988 due to a suicidal attempt, indicating
that, upon admission, he was found to be anxious, with
blunted affect, fair concentration, and fair judgment and
insight. He was treated with medication. As noted above,
the discharge diagnosis was adjustment disorder, with
depressed mood. Subsequently received in October 1989 was a
page from the November 1987 hospital summary, reflecting
diagnoses of alcohol abuse and mixed personality disorder.
Received in May 1992 was a report from the Naval Hospital in
San Diego, dated in December 1987, indicating that the
veteran had been admitted to the hospital's psychiatric
service on November 24, 1987, and discharged on December 1,
1987. This admission has been discussed in detail above.
The report also indicated that the discharge diagnoses were
alcohol dependence; psychoactive substance abuse, NOS (not
otherwise specified); and mixed personality disorder, NOS,
manifested by immature and antisocial traits. Also received
in May 1992 was a copy of a letter sent from the Assistant
Secretary of the Navy to the veteran's mother, dated in
August 1984, informing her that he was doing well and had
adapted to the military way of life.
Received in August 1992 was a statement from the veteran's
mother, indicating that her son was discharged from service
for "other physical/mental condition-personality disorder."
She expressed her belief that the Navy hounded her son and
destroyed his personality. Received in September 1992 were
several lay statements from Assistant Secretaries of the
Navy, dated from July 1983 to July 1984, the contents of
which were previously reported and discussed above.
Received in September 1992 was the report of a Social
Security Administration (SSA) decision, dated in November
1989, indicating that the veteran filed an application for
disability benefits in June 1989, based upon a psychiatric
disorder. The SSA decision concluded that the medical
evidence established the veteran had severe affective
disorder, a major depression, and personality disorder, as
well as alcoholism. Received in July 1993 were duplicate
service medical records, dated from October 1982 to October
1987, previously reported above. Subsequently received in
February 1994 were duplicate lay statements, dated from June
1983 to July 1985, previously reported above.
Received in January 1996 were medical records from SSA dated
from January 1988 to May 1988, which show that the veteran
received clinical attention and treatment for several
disabilities, including a psychiatric disorder. A VA
progress note dated in April 1988 indicates that the veteran
was referred to the hospital by Dr. Cruz Mena, with a
diagnosis of major depression and depressed mood. A
treatment report dated in July 1988 reflects a diagnosis of
affective disorder. Among the records was the report of a
psychiatric evaluation, conducted in March 1989, indicating
that the veteran complained of anxiety and depression.
Following a mental status examination, the pertinent
diagnosis was schizoid, DSM III, vs. borderline personality
disorder.
Received in January 1997 were VA progress notes dated from
January 1988 to May 1988, which show that the veteran was
seen on a regular basis at the mental health clinic for
symptoms associated with a psychiatric disorder. Among the
records was a treatment report dated in January 1988,
reflecting diagnoses of borderline personality disorder and
anxiety depressive reaction. Also received in January 1997
were private treatment reports dated from November 1989 to
February 1990, consisting of psychiatric evaluations. During
an evaluation in November 1989, the veteran reported that,
during his adolescence, he had experienced difficulty in
maintaining interpersonal relationships, and had only been
interested in passive activities. Following a mental status
evaluation, the examiner stated that the veteran showed
characteristics of an avoidance-type personality disorder. A
follow-up evaluation, conducted in January 1990, confirmed
the previous finding that the veteran appeared to be
suffering from an avoidance personality disorder.
Received in March 1998 were private treatment reports dated
from August 1994 to January 1997. In August 1994, the
veteran was referred for a psychological evaluation to
understand adjustment patterns, abilities, achievements, and
personality dynamics; provide information relevant to
diagnosis and levels of functioning; and assist in
determining areas for counseling and guidance. The
psychologist reported that the MCMI-II profile was consistent
with the veteran's self report of having a prior diagnosis of
a personality disorder. The pertinent diagnostic impression
was personality disorder, NOS, with schizoid and avoidant
traits. The records indicate that the veteran was
subsequently referred for several sessions of individual
psychological counseling for treatment of a schizoid and
avoidant pattern of behavior associated with his previously
diagnosed personality disorder. The veteran was again
referred for a psychological evaluation in January 1997; at
that time, the impression was social phobia; personality
disorder, NOS, with signs of both avoidant and schizoid
personality features.
Also received in March 1998 were private treatment reports
dated from March 1997 to July 1997, which showed ongoing
clinical evaluation and treatment for the veteran's
psychiatric disorder. In a medical statement from Joe H.
Berry, M.D., dated in March 1997, it was noted that the
veteran was seen for evaluation, at which time he reported
suffering from wide mood swings. The diagnostic impression
was panic disorder with agoraphobia; "rule out" bipolar
disorder; and borderline personality disorder. During a
subsequent clinical visit in April 1997, Dr. Berry indicated
that a more appropriate diagnosis for the veteran was bipolar
I disorder with associated panic attacks. In a statement
dated in July 1997, Dr. Berry reported a diagnosis of bipolar
I disorder, most recent episode mixed.
The veteran was afforded a VA compensation examination in
July 1999, at which time it was noted that he had an
extensive family history of mental illness. It was noted
that the veteran had the understanding that bipolar disorder
was an inherited disorder and admitted that he himself
suffered from it as well. The veteran indicated that he had
failed miserably in the job market due to his tendency to be
paranoid and get involved in conflicts with colleagues and
supervisors. He also explained that he was proud to serve in
the military, but he got angry about being discharged because
he was sick. Following a mental status examination, the
examiner stated that it was apparent that the veteran
suffered from bipolar disorder; that he displayed the classic
symptoms of bipolar disorder, and that there was a clear
family history of bipolar disorder. That was the pertinent
diagnosis.
Of record are addenda to the above VA examination, dated in
March 2000. The first addendum is dated March 7, 2000,
wherein the evaluator noted that there was an extended family
history of mental illness, apparently bipolar disorder, which
no doubt had a genetic origin. The examiner reported that,
although the veteran's bipolar disorder did appear to have
become apparent and worsened during his time in service, he
would no doubt have developed symptoms of bipolar disorder
had he remained a civilian. The examiner further opined that
the veteran's bipolar disorder did not appear to have been
significantly exacerbated by military service over and above
what one would have expected had he been engaged in normal
activities in civilian life. In a subsequent addendum dated
March 10, 2000, another VA examiner agreed that the veteran
had multiple family problems including a history of mental
illness, and that his acting-out teenage behavior might have
been a forerunner of his current condition, but did not
appear to manifest itself when he was in the military.
II. Legal analysis
Under applicable law, service connection may be granted for a
disability resulting from disease or injury which was
incurred in, or aggravated by, active military service.
38 U.S.C.A. §§ 1110, 1131 (West 1991). To establish a
showing of chronic disease in service, there is required a
combination of manifestations sufficient to identify the
disease entity, and sufficient observation to establish
chronicity at the time. 38 C.F.R. § 3.303(b) (2000). If
chronicity in service is not established, a showing of
continuity of symptoms after discharge is required to support
the claim. Id.
Service connection may also be granted for any disease
diagnosed after discharge, when all of the evidence
establishes that the disease was incurred in service.
38 C.F.R. § 3.303(d). In addition, service incurrence will
be presumed for certain chronic diseases, including
psychoses, if manifest to a compensable degree within one
year after separation from active service. 38 U.S.C.A.
§§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.
Under basic principles relating to service connection, a
lifelong pattern of action or behavior manifesting
developmental defects or pathological trends in the
personality structure due to a personality disorder is
considered to be of preservice origin, and personality
disorders are not diseases or injuries within the meaning of
applicable legislation. The law is clear that a personality
disorder is not a disability for which service connection may
be granted for VA compensation purposes. 38 C.F.R. §§
3.303(c), 4.9, 4.127. See Winn v. Brown, 8 Vet.App. 510, 516
(1996), appeal dismissed, 110 F.3d 56 (Fed. Cir. 1997)
(specifically holding that "38 C.F.R. § 3.303(c), as it
pertains to personality disorder, is a valid exercise of the
authority granted to the Secretary of Veterans Affairs").
See also Beno v. Principi, 3 Vet. App. 439, 441 (1992).
The law further provides that a veteran shall be presumed to
have been in sound condition at the time of acceptance for
service, except for defects noted at that time or where clear
and unmistakable evidence demonstrates that the disability or
disease existed prior to service and was not aggravated by
such service. 38 U.S.C.A. §§ 1111, 1137; 38 C.F.R. §
3.304(b). A preexisting disability or disease will be
considered to have been aggravated by active service when
there is an increase in disability during service, unless
there is clear and unmistakable evidence (obvious and
manifest) that the increase in disability is due to the
natural progress of the disability or disease. 38 U.S.C.A.
§ 1153; 38 C.F.R. § 3.306(a), (b).
Aggravation may not be conceded where the disability
underwent no increase in severity during service on the basis
of all the evidence of record pertaining to the
manifestations of the disability prior to, during, and
subsequent to service. 38 C.F.R. § 3.306(b). See Falzone v.
Brown, 8 Vet.App. 398, 402 (1995) (holding that the
presumption of aggravation created by section 3.306 applies
only if there is an increase in severity during service);
Akins v. Derwinski, 1 Vet.App. 228, 231 (1991).
The United States Court of Appeals for Veterans Claims has
further stated that "temporary or intermittent flare-ups
during service of a preexisting injury or disease are not
sufficient to be considered 'aggravation in service' unless
the underlying condition, as contrasted to the symptoms, is
worsened." Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991);
see also Daniels v. Gober, 10 Vet.App. 474, 479 (1997); see
also Browder v. Brown, 5 Vet.App. 268, 271 (1993) (Board must
"explain the criteria it used to determine whether there was
an increase in disability of [the preexisting condition]
during service and how, pursuant to such criteria, it
concluded that [there was no in-service worsening]").
It is clear that "[t]he regulations regarding service
connection do not require that a veteran must establish
service connection through medical records alone."
Triplette v. Principi, 4 Vet.App. 45, 49 (1993), citing
Cartright v. Derwinski, 2 Vet.App. 24, 25 (1991). It is
equally clear, however, that the resolution of issues which
involve medical knowledge, such as the diagnosis of
disability and determination of medical etiology, require
professional evidence. See Espiritu v. Derwinski, 2 Vet.App.
492, 495 (1992). See also Routen v. Brown, 10 Vet.App. 183,
186 (1997) ("a layperson is generally not capable of opining
on matters requiring medical knowledge"), aff'd sub nom.
Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998), cert. denied,
119 S. Ct. 404 (1998).
We will digress for a moment to note that, until very
recently, the RO and the Board were required by law to assess
every claim, before completing our adjudication as to the its
merits under substantive law, to determine whether it was
well grounded, pursuant to 38 U.S.C.A. § 5107(a) (West 1991).
A claimant seeking benefits under a law administered by the
Secretary of Veterans Affairs had the burden to submit
sufficient evidence to justify a belief by a fair and
impartial individual that the claim was well-grounded; then,
if that burden was met, VA had the duty to assist the
claimant in developing additional evidence pertaining to the
claim. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet.
App. 78, 81-2 (1990); Lathan v. Brown, 7 Vet. App. 359, 365
(1995). If the burden was not met, the duty to assist
pursuant to section 5107(a) did not attach. Anderson v.
Brown, 9 Vet. App. 542, 546 (1996). Indeed, if the claim was
not well-grounded, the Board was without jurisdiction to
adjudicate it. Boeck v. Brown, 6 Vet. App. 14, 17 (1993).
A well-grounded claim was defined as a plausible claim,
either meritorious on its own or capable of substantiation.
See Murphy, supra. Under that analysis, a claim for service
connection required three elements in order to be well-
grounded. There was required to be competent evidence of a
current disability (a medical diagnosis); incurrence or
aggravation of a disease or injury in service (lay or medical
evidence); and a nexus between the in-service injury or
disease and the current disability (medical evidence). The
third element could also be established by the use of
statutory presumptions. See Caluza v. Brown, 7 Vet. App.
498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir.
1996) (table).
The well-grounded-claim rubric was important because, in Epps
v. Gober, 126 F.3d 1464 (Fed. Cir. 1997), cert. denied sub
nom. Epps v. West, 118 S. Ct. 2348 (1998), the United States
Court of Appeals for the Federal Circuit confirmed that,
under section 5107(a), the Department of Veterans Affairs
(VA) had a duty to assist only those claimants who had
established well-grounded claims. More recently, the Court
of Appeals for Veterans Claims had issued a decision holding
that VA was not permitted to assist a claimant in developing
a claim which was not well-grounded. Morton v. West, 12 Vet.
App. 477 (July 14, 1999), en banc review denied, 13 Vet. App.
205 (1999) (per curiam), remanded sub nom. Morton v. Gober,
No. 99-7191 (Fed. Cir. Aug. 17, 2000) (unpublished per curiam
order), opinion withdrawn and appeal dismissed, 14 Vet. App.
___, No. 96-1517
(Nov. 6, 2000) (per curiam).
We observe that the United States Congress has recently
passed, and the President has signed into law, legislation
repealing the requirement that a claim be well grounded.
Several bills were involved in that process, and the
legislation which now governs cases such as this is the
Veterans Claims Assistance Act of 2000, Public Law No. 106-
475, 114 Stat. 2096.
The aforementioned statute, enacted on November 9, 2000,
contains a number of new provisions pertaining to claims
development procedures, including assistance to be provided
to claimants by the RO, notification as to evidentiary
requirements, and the obtaining of medical examinations and
opinions to attempt to establish service connection. We have
carefully reviewed the veteran's claims file, to ascertain
whether remand to the RO is necessary in order to assure
compliance with the new legislation. Based upon the
extensive development of medical evidence, including records
submitted by the veteran and his representative, and multiple
examinations of the veteran by VA, the Board concludes that
all reasonable efforts have been made to compile a complete
record for our decision, and that the veteran has had
adequate notice of the evidence needed to substantiate his
claim.
In rendering our decision, the Board must account for the
evidence that we find to be persuasive and unpersuasive, and
provide reasoned analysis for accepting or rejecting evidence
submitted by and on behalf of the claimant. See Gilbert v.
Derwinski, 1 Vet.App. 49 (1990). For the Board to deny a
claim on its merits, the evidence must preponderate against
the claim. Alemany v. Brown, 9 Vet.App. 518 (1996), citing
Gilbert, at 54. It is the task of the Board to assess the
credibility and probative value of the evidence and render
its decision. See Evans v. West, 12 Vet. App. 22, 30 (1998).
It is also the responsibility of the Board to determine the
probative weight to be ascribed as among multiple medical
opinions in a case, and to state reasons or bases for
favoring one opinion over another. See Winsett v. West, 11
Vet.App. 420, 424-25 (1998). The probative value of a
physician's statement is dependent, in part, upon the extent
to which it reflects "clinical data or other rationale to
support his opinion." Bloom v. West, 12 Vet.App. 185, 187
(1999).
When there is an approximate balance of positive and negative
evidence regarding the merits of an issue material to the
determination of the matter, the benefit of the doubt in
resolving each such issue shall be given to the claimant.
38 U.S.C.A. § 5107(b) (West 1991); Pub. L. No. 106-475, § 4,
114 Stat. 2096, ____ (2000) (to be codified as amended at
38 U.S.C.A. § 5107(b)); 38 C.F.R. § 3.102.
The veteran contends, essentially, that he developed a
psychiatric disorder as a result of his military service.
The Board acknowledges that the report of the veteran's
entrance examination did not then reveal any psychiatric
defects. However, the law and relevant VA regulations
mandate that the presumption of soundness upon entry into
service may be rebutted by clear and unmistakable evidence
showing that an injury or disease existed prior to service.
As the Court of Appeals for Veterans Claims has held, the
presumption of soundness may not be rebutted without
"contemporaneous clinical evidence or recorded history" in
the record. Miller v. West, 11 Vet.App. 345, 348 (1998). We
note that the Federal Circuit Court has clarified the Miller
decision by noting that "[n]othing in the court's opinion
suggests that without such evidence the presumption can never
be rebutted," emphasizing that any such determination must
consider "how strong the other rebutting evidence might
be." Harris v. West, 203 F.3d. 1347, 1351 (Fed. Cir. 2000),
cert. denied, 120 S. Ct. 2745 (2000).
In this regard, we observe that the treatment notes
pertaining to his treatment during service include the
veteran's acknowledgment that he had experienced recurrent
suicidal thoughts for the previous 10 years; in fact, during
a clinical evaluation in September 1987, the veteran gave a
history of multiple behavioral problems in school since the
sixth grade, and of legal problems. In addition, during his
period of hospitalization in late November 1987, the veteran
indicated that he had been a member of a street gang and had
been arrested for crimes four times prior to service. He
described extensive illicit drug abuse before service,
including chemicals such as THC, cocaine, LSD, and
amphetamines. The diagnostic conclusion which emerged from
that hospitalization was that the veteran suffered from
alcohol abuse; psychoactive substance abuse; and a
personality disorder of mixed type. It is also noteworthy
that, in an addendum to the July 1999 VA examination dated in
March 2000, the VA examiner noted that the veteran's acting-
out behavior as a teenager might have been a forerunner of
his current bipolar disorder.
In light of the above, the Board concludes that the record
presents clear and unmistakable evidence of a psychiatric
disorder, however diagnosed, which existed prior to the
veteran's induction into active military service.
38 U.S.C.A. § 1111; 38 C.F.R. § 3.304. Thus, the presumption
of soundness at entry, to which the veteran would otherwise
be entitled, is rebutted.
Therefore, in order to warrant service connection, it must be
shown that the veteran's psychiatric disorder, which
preexisted service, was aggravated, that is, permanently
worsened, during service. As noted above, there must be a
showing that the veteran's underlying psychiatric disorder,
as contrasted to merely the symptoms thereof, increased in
severity. The Board finds that the evidence does not
demonstrate any permanent increase in severity of the
psychiatric disorder during the veteran's active duty. The
psychiatric symptoms reported during service are essentially
similar to those reported prior to service. Moreover, the
psychiatric symptoms reported immediately after his
separation from service essentially mirror those prior to and
during service.
As sympathetic as we might be toward a veteran's claim, the
Board is not permitted to reach medical determinations
without considering independent medical evidence to support
our findings, and we must cite to competent evidence of
record to support our conclusions. See Rucker v. Brown, 10
Vet.App. 67, 74 (1997), citing Colvin v. Derwinski, 1
Vet.App. 171 (1991), and Hatlestad v. Derwinski, 3 Vet. App.
213 (1992). Having reviewed the medical records in this
case, we can find none supporting the veteran's contention
that he incurred a permanent degree of aggravation of his
preservice psychiatric disorder in service.
Significantly, in a second addendum to the July 1999 VA
examination, dated in March 2000, the VA examiner explained
that, while the veteran's bipolar disorder appeared to have
become apparent and worsened during his time in service, he
would have developed symptoms of bipolar disorder had he
remained a civilian. The examiner added that the bipolar
disorder did not appear to be significantly exacerbated by
military service over and above what one would have expected
had he been engaged in normal activities in civilian life.
In other words, to whatever extent the veteran's preservice
psychiatric disorder increased in service, any such increase
represented the natural progress of the disorder, and is not
attributable to service.
Finally, we would note that, although the law accords a
presumptive period of one year after service separation in
which manifestation of a psychotic mental disorder may be
service connected, there was no psychosis diagnosed within
the first postservice year, or at any time in this case.
Various diagnoses, such as adjustment disorder, affective
disorder, bipolar disorder, depressive disorder, panic
disorder, and dysthymia, have been noted, in addition to a
personality disorder and alcoholism. None, however, has been
shown by the medical evidence to have been incurred in or
aggravated by service.
We recognize that records of the Social Security
Administration indicate that the veteran has been found to be
entitled to disability benefits from that agency. It must be
remembered, however, that SSA's eligibility criteria are not
concerned with whether the claimed disorders are related in
any way to military service. Moreover, although it may be
permissible for SSA to pay benefits for a personality
disorder under its governing law, VA has a specific bar,
discussed above, against granting compensation for such a
disorder.
In summary, the evidence in its entirety does not establish
that there was any permanent increase in severity of the
veteran's preexisting psychiatric disability during service,
and, if there was an increase, it was due to natural
progress. Accordingly, under the circumstances, the Board
concludes that his preexisting psychiatric disability was not
aggravated during his military service. 38 U.S.C.A. § 1153;
38 C.F.R. § 3.306(a). Service connection for the veteran's
psychiatric disability is therefore not warranted. The Board
has carefully reviewed the entire record in this case, and we
do not find the evidence to be so evenly balanced that there
is reasonable doubt as to any material issue. 38 U.S.C.A.
§ 5107(b).
ORDER
Service connection for a psychiatric disorder is denied.
ANDREW J. MULLEN
Member, Board of Veterans' Appeals